背景:血管和神经浸润是胃癌进展和预后的重要指标,但传统的影像学方法在术前评估中存在一定的局限性。近年来,能谱计算机断层扫描(CT)多参数成像技术因其在组织造影和病变细节显示等方面的优势,逐渐应用于临床。
目的:探讨和分析多参数能谱CT成像在胃癌患者术前评估血管侵犯(LVI)和神经侵犯(PNI)中的应用价值。
方法:资料来自我院2022年9月至2023年9月期间经病理证实并伴有能谱CT扫描的GC患者62例,其中男46例,女16例,年龄36-71(57.5±9.1)岁,是回顾性收集的。根据LVI/PNI的存在将患者分为阳性组(42例)和阴性组(20例)。CT值(CT40keV,CT70keV),碘浓度(IC),动脉期的上能谱CT图像中病变的归一化IC(NIC),静脉期,并测量了延迟相位40和70keV,计算了能量谱曲线[K(40-70)]从40到70keV的斜率。动脉相位组合参数,静脉期联合参数(VP-ALLs),计算晚期疾病患者的延迟相位关联参数。比较正负组间的能谱参数差异,绘制受试者工作特性(ROC)曲线,和曲线下面积(AUC),灵敏度,特异性,并计算最佳阈值来衡量每个参数的诊断效率。
结果:在延迟阶段,CT40keV,CT70keV,K(40-70),IC,NIC,LVI/PNI阳性组的能谱CT上动脉和静脉期的CT70keV和NIC大于LVI阴性组。动脉期NIC的代表性参数阳性组为0.14±0.04,阴性组为0.12±0.04。静脉期NIC阳性组为0.5(0.5,0.6),阴性组为0.4(0.4,0.5)。最后,对于延迟相位NIC,阳性组为0.6±0.1,阴性组为0.5±0.1(P值均小于0.05)。ROC曲线分析表明,静脉期各参数的诊断效能优于动脉期和延迟期。此外,综合参数在所有三个阶段的诊断效能均优于任何单一参数.AUC,灵敏度,和最佳参数的特异性,副总裁,为0.931(95%置信区间:0.872-0.990),80.95%,和95.00%,分别。
结论:在手术前评估GC患者的LVI和PNI(神经周浸润)状况时,使用静脉分期参数诊断这些疾病的能力优于使用动脉分期和延迟分期参数.此外,联合使用参数的诊断准确性优于单独使用单个参数的诊断准确性.
BACKGROUND: Vascular and nerve infiltration are important indicators for the progression and prognosis of gastric cancer (GC), but traditional imaging methods have some limitations in preoperative evaluation. In recent years, energy spectrum computed tomography (CT) multiparameter imaging technology has been gradually applied in clinical practice because of its advantages in tissue contrast and lesion detail display.
OBJECTIVE: To explore and analyze the value of multiparameter energy spectrum CT imaging in the preoperative assessment of vascular invasion (LVI) and nerve invasion (PNI) in GC patients.
METHODS: Data from 62 patients with GC confirmed by pathology and accompanied by energy spectrum CT scanning at our hospital between September 2022 and September 2023, including 46 males and 16 females aged 36-71 (57.5 ± 9.1) years, were retrospectively collected. The patients were divided into a positive group (42 patients) and a negative group (20 patients) according to the presence of LVI/PNI. The CT values (CT40 keV, CT70 keV), iodine concentration (IC), and normalized IC (NIC) of lesions in the upper energy spectrum CT images of the arterial phase, venous phase, and delayed phase 40 and 70 keV were measured, and the slopes of the energy spectrum curves [K (40-70)] from 40 to 70 keV were calculated. Arterial phase combined parameter, venous phase combined parameters (VP-ALLs), and delayed phase association parameters were calculated for patients with late-stage disease. The differences in the energy spectrum parameters between the positive and negative groups were compared, receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC), sensitivity, specificity, and optimal threshold were calculated to measure the diagnostic efficiency of each parameter.
RESULTS: In the delayed phase, the CT40 keV, CT70 keV, K (40-70), IC, NIC, and CT70 keV and the NIC in the upper arterial and venous phases of energy spectrum CT were greater in the LVI/PNI-positive group than in the LVI-negative group. The representative parameters for the arterial phase NIC were 0.14 ± 0.04 in the positive group and 0.12 ± 0.04 in the negative group. The venous phase NIC was 0.5 (0.5, 0.6) in the positive group and 0.4 (0.4, 0.5) in the negative group. Last, for the delayed phase NIC, it was 0.6 ± 0.1 in the positive group and 0.5 ± 0.1 in the negative group (all P values are less than 0.05). ROC curve analysis demonstrated that the diagnostic efficacy of each parameter during the venous stage was superior to that during the arterial and delayed stages. Furthermore, the diagnostic efficacy of the combined parameter throughout all three stages was superior to that of any single parameter. The AUC, sensitivity, and specificity of the optimal parameter, VP-ALL, were 0.931 (95% confidence interval: 0.872-0.990), 80.95%, and 95.00%, respectively.
CONCLUSIONS: When assessing the condition of LVI and PNI (perineural invasion) in patients with GC prior to surgery, the ability to diagnose these conditions using venous stage parameters was superior to that using arterial stage and delayed stage parameters. Furthermore, the diagnostic accuracy of using a combination of parameters was better than that of using individual parameters alone.